The IFMSA delegation to the fifth session of the open working group on sustainable development goals, 25-27th November 2013, part of the United Nation Major Group of Children Youth.

Sustainable Development Goals: Realizing the World We Want

The UN Open Working Group (OWG) on Sustainable Development Goals (SDGs) was created to allow for a global conversation around a new development agenda for post-2015. SDGs are based upon the Millennium Development Goals (MDGs) established in 2000 which has guided the development agenda for the past fifteen years. The process of developing SDGs, which started in March 2013, includes a set of eleven multi-stakeholder thematic consultations involving delegates from members’ states, United Nations Groups, and the civil society.

Health in the Development of a Sustainable Development Framework

Health is a “precondition for, an outcome of, and an indicator of all three dimensions of sustainable development”[i] : social, economy and environment. Therefore, it needs to be a crosscutting issue in the post-2015 SDGs. The protection and the promotion of health and wellbeing of all people of all ages can be part of all potential SDGs. Proposed goals and targets should include health-sensitive indicators.

The framework needs to promote action to achieve human development and promotes human health and wellbeing through the following[ii] :

Promotion of human rights for all, by ensuring enabling environments for the protection of human rights

A focus on the poorest and most vulnerable and marginalized populations: sexual minorities, older people, people with disabilities, NDCs and migrants.

Promotion of policies and programs supporting health and development throughout the life course, and ensuring access to services to minimize the social and economic impacts of experiencing a health condition

Active and meaningful engagement with nongovernmental organizations and civil society

Clear and strong accountability mechanisms, with adequate and sustainable financing

Fifth Session: Health as a Sustainable and Inclusive Economic Issue

“There is a sense of urgency.” “The Social Agenda has to be a strong consensus. Goals must be few, measurable, and easy to communicate.” “We must leave no one behind.” Macharia Kamau opens the fifth working group session. On Monday morning, co-chairs Körösi and Kamau lead the session on sustained and inclusive economic growth, macroeconomic policy questions (including international trade, international system and external debt sustainability), infrastructure development and industrialization.

What is sustainable and inclusive industrialization? It is national economic growth and policies that take under consideration social issues such as public health, food security, gender equity and decent employment, as well as taking environmental issues into consideration.

As a medical student, engaged citizen, and on behalf of the UN Major Group of Children and Youth, I believe that it is essential to promote health in the SDG framework on future and re-negotiated trade and investment agreements. Therefore, international trade agreements must not undermine public health, and should address tobacco control, access to medicine, and technology access. Inclusive economic growth is directly linked to poverty, inequalities, and determinants of health.

I recommend the inclusion of policies that ensure allocation of resources to support the implementation of universal health coverage (UHC) and access. I recommend targets to promote measures to decrease indoor and outdoor air pollution as the use of accessible, active and public transport. I recommend a target to increase national tax revenues and economic capacity through taxation on products that contributes to poor health outcome. Fiscal policy is a powerful tool for encouraging health-promotion behaviours.

Those recommendations were to be discussed with the delegates. One of our goals was to talk to the representatives from member states about health issues. To accomplish this, we were tracking, which means to write what each delegate was saying in short key points. After the sessions, we therefore approached them in one-on-one fashion according to our knowledge and ties to individual countries. Engaging discussion on health issues linked to energy or macroeconomics allowed for inspiring discussions with some delegates as well as for the sharing of our position.

During the sessions, the question of financial stability was repetitive. It requires transformation at an international level. Unfortunately, we did not hear concrete propositions about how the financial system can be transformed to support sustainable initiatives; therefore, fiscal policies to support countries in their sustainable efforts are necessary. Calls for donors to reaffirm their goals to allocate 0.7 % of the gross domestic product to foreign aid and to allocate funds especially for improving health outcomes according to current epidemiological trends are strongly voiced. [iii]

Fifth Session: Health as an Energy Issue

The second half of the working group was devote to Energy issue. “Energy is the golden thread that connects economic growth, social equity, and environmental sustainability” Ban Ki-Moon, UN Secretary-General. We believe that the inclusion of indicators to measure the health equity impacts of energy policies can benefit from access to energy. We also support indicators to measure indoor and outdoor air pollution exposure, according to WHO’s assessment of ambient air pollution concentrations[iv]. Some countries talked about the interlinkages between energy and health, as well as interlinkages with many other issues like gender, economy and poverty. Energy, especially renewable energy, is a strong promoter of health.

Sustainable Economy on Health Outcomes– National Taxation of tobacco or other unhealthy products– Interdiction of non-therapeutic use of antibiotics in livestock production, as this contributes to increasing resistance in humans– Support eradication of malaria, AIDS and tuberculosis– Support to reduce tropical diseases and non-communicable diseases– Support free-smoke decent job– Policy to protect sexual and reproductive health and rights of women and adolescent girls

4 million people die per year as a result of exposure to smoke (cook stoves or open fires). 3, 3 million people die each year from exposure to outdoor air pollution. [v]

Those statistics were mentioned not only by UN major groups, but also by delegates from varied continents. Everybody agreed: energy access for all is essential to the achievement of the post-2015 agenda. However, a major question remains unanswered: how do we address energy when access for all and equity is needed as well as a transformation of energy systems to green energy alternatives?

Things we found missing in the discussions

Growth, growth, growthAlthough the need for growth is understandable for development, this cannot be the single target of macroeconomic policies. Growth must most importantly be managed in a sustainable manner within planetary boundaries. How about mentioning an economist’s worst nightmare: managed economic compression in regions / economic areas that are highly unsustainable in their practices instead of only managed growth. The closest we came to hearing such bold ideas was through discussions of increased energy efficiency.

Growth is not the direct equivalence of development. Actually, these two terms refer to quite opposite concepts. Growth can be defined by the unique expansion of something such as the economy, and this is not necessarily good. Development on the other hand refers to a constant evolution toward something better.

Youth presence MGCY certainly had a strong delegation and there were a few UN interns present as well, but we found low youth participation. We were told by MGCY representatives that youth participation in this session was significantly lower than usual and indeed, the IFMSA delegation represented more than half of the MGCY members present at any single point in time. An important way to ensure intergenerational equity in major UN discussions is by involving youth in official member state delegation; this is something that we would like to see both in future OWG session and in other international forums.

Youth voice to promote health and equity in the post-2015 agenda is essential. Youth must be engaged in this process. Monday afternoon, Professor Jeffrey Sachs, Director of the UN Sustainable Development Solutions Network and Director of The Earth Institute, exclaims that we are running out of time and of safe space, that the work of these SDGs is essential and that it needs to inspire the world, and most important, SDGs post-post 2015 must “Empower the young people”.

Concluding Thoughts

The MDGs were without a doubt historic and monumental, but regardless, were riddled with problems and short-failings. However, the spirit at OWG5 is impressively positive and constructive in this regard. Although the group in general seems to recognize the failings of MDGs, they are regardless looking forward with bold optimism. Lessons learned from the MDGs center around sustainability, multi-dimensional targets and statistical indicators. Conversations, without a doubt, emphasize that although MDGs highlighted social needs in a unified context, these social and humanitarian goals cannot be achieved without the economic development, and consequent public capital, to spend on social avenues. Secondly, the problem of silo-ing in the MDGs occurred by the creation of single-facet goals (ie: one goal for education, one goal for health, etc.). However, this compartmentalization does not reflect reality. Issues are intertwined and networked in complex fashions, which needs to be reflected in new SDGs and their respective targets.

Although this has been discussed at the OWG5, our lobbying efforts have noticed some resilience in taking a fully integrative approach. As soon as health seems to be mentioned, economy-focussed ears and minds close up. This is the goal of our lobbying efforts this week: to try and persuade delegates that health is a multi-dimensional goal, and is necessary but not sufficient for sustainable economic development. New indicators that measure human well-being and health must be used to evaluate economic progress in the future. Although the final outcomes of our advocacy efforts will not be seen for years to come, it has been monumental to be part of these constructively critical conversations that will set a new development precedent for history.

Climate change is already having profound effects on health, with the WHO estimating it to directly cause over 200,000 deaths annually. If we continue along the same path, this will escalate dramatically fast. One of the most terrifying things about climate change is that it will affect the most vulnerable people, those living in the poorest countries. They, who are the least responsible for climate change, will bear a far larger burden than citizens from the richest countries. Inequalities in social and economic development, education, accessibility and quality of basic health care, infrastructures and public policy, will play a crucial part in determining the national impact of climate change. Once again, the poorest populations will be hit the hardest.

Climate change has important health impacts and given the inequitable distribution of its consequences, it is contributing to increasing health disparities between developing and developed countries. (1,2) Quantitatively, climate change was estimated to be responsible for “154 000 (0.3%) deaths and the attributable burden was 5.5 million (0.4%) DALYs” in 2000.(3). The World Bank estimates, in a recent report, that a 4 oC warmer world is so different from the current one that it comes with high uncertainty and new risks that threaten our ability to anticipate and plan for future adaptation needs. Isn’t that scary ?

In only a few days, thousands will gather in Warsaw (Poland) for the 19th meeting of the Conferences of Parties (COP19) for the UN Framework Convention on Climate Change (UNFCCC). This intergovernmental process has been operating since 1994, and serves as the international forum for negotiations and discussions on global action to combat climate change. The conference will see over 10,000 experts in climate change, sustainability, and development come together for two weeks from November 11 – 22 to piece together the initial building blocks of a new global (hopefully binding) agreement, to be delivered in 2015 at COP21 in Paris. You can find all information about COP19 on the official website: http://www.cop19.gov.pl/.

In the past years, IFMSA has been one of the leading NGOs, delivering powerful interventions, organizing massive mobilisation, leading youth efforts, and above all, advocating for a bigger health consideration in the COPs negotiations. It also works together as part of the Global Climate and Health Alliance (GCHA) to advocate for policies which promote human health and protect the planet. The Alliance is managed by a number of leading, international environment and health organisations, coordinating their international policy and communications strategy at the UNFCCC.

“We need to bring the two agendas of health equity and climate change together” – WHO Commission on Social Determinants of Health

At this years climate talks, IFMSA will have a delegation consisting of five people from all over the world, led by Charlotte Holm-Hansen from IMCC-Denmark. The delegation will mainly focus on promotion of the second Global Climate and Health Summit, youth participation and how health should not be seen isolated but how health co-benefits can strengthen other issues. The delegation will be blogging daily, and can be followed on Facebook and Twitter (using the hashtag #IFMSACOP19).

On the 16th of November (in parallel with COP19), the GCHA is holding the second Global Climate and Health Summit, which will develop a road-map for the international health community to mobilise around in the lead up to COP21 in 2015. If you’re in Poland at the time, you can register for the Summit here.

We, as young people and as medical students, have no choice but to act. As the WHO Commission on Social Determinants of Health states, “we need to bring the two agendas of health equity and climate change together”. If you are interested in getting more involved in IFMSA climate health efforts, join our Think Global Team (call is open until November 24th!); set up IFMSA project “Healthy Planet International” at home; follow the Federation’s delegation to COP19 (on twitter: #IFMSACOP19); sign the Climate & Health Council Pledge; look at Global Climate & Health Alliance resources; and email us for more ideas right here at thinkglobal@ifmsa.org.

Over the few past days, we have been lucky enough to attend the fifth World Health Summit, held in Berlin. This meeting gathers together hundreds of global health actors, leaders and stakeholders. The aim of the WHS is to improve health worldwide through catalysing collaboration and open dialogue thereby setting tomorrow’s agenda for improved research, education, health care and policy outcomes.

The WHS was preceded by the student satellite workshop, “Building future leaders, health in all policies” co-organised by bvmd-Germany, UAEM, IFMSA and EMSA. The agenda of the satellite event was broad but topics that featured particularly were Universal Health Coverage in the framework of the post 2015 agenda and global health education. Among other discussions, the idea of health in all policies and global health diplomacy were discussed at length, two concepts that we judge to be at heart of global health these days (and that we hope you will get to know better this year via the Think Global Initiative!).

So what is “Health in all policies.” This is a phrase who has be coined by WHO and aims to capture the notion that health is far-reaching (social determinants of health), well beyond the health sector and that health should be taken into consideration in policy development from all sectors. Contrasting health students’ ideas for policies in the areas of economics, water and education with those suggested by the United Nations allowed us to consider how other sectors consider health, coming to the conclusions that in general sectors are happy to siphon off areas of responsibility to the health sector if possible.

In our globalized increasingly complex and interdependent world, health has become an integral part of three global agendas: security, economic and social justice.

Global Health Diplomacy, on the other hand, ties together health and foreign policies. As developed by Ilona Kickbush – who was kind enough to give one of the students’ debriefings during the World Health Summit – global health diplomacy can be defined as the “multi-level and multi-actor negotiation processes that shape and manage the global policy environment for health”. Furthermore, in our globalized increasingly complex and interdependent world, health has become an integral part of three global agendas: security, economic and social justice. Many countries, including the United States, Norway, Japan and more recently Germany, have established national Global Health strategies and some even set up specialized offices.

However, it is easy to see that many questions arise around this topic: is global health diplomacy really serving for a better world or is it used to push a not-so hidden agenda? On the international level, global health diplomacy has become more prominent in the past two decades, especially with the international pledge to meet the millennium development goals by 2015, three of them being directly related to health issues. As members states and civil society are currently discussing the sustainable development goals (the famous post-2015 global agenda), we can only be sure that the concept of global health diplomacy will become more important as there is a growing awareness that investment in health is fundamental to economic growth and development, as the Oslo ministerial declaration of 2007 states.

We had the chance to further understand those two issues during the Summit itself, with a program jump-packed with various talks by diplomats, ministers, health leaders, global stakeholders. The different agenda items focused on themes such as research and innovation, education and leadership, evidence to policy, and global health for development. But educational as all the sessions clearly were, it was extremely refreshing to hear Sir Michael Marmot bring the discussion back to social determinants of health. Bold statements such as “I want to see economics debated as if people matter” resonated strongly with the youth contingent at the conferences and Sir’s closing statement of , “Do something, do more, do better” will continue to motivate us.

There is enough money to do whatever we want. We aren’t limited by resources but by their distribution. – Marmot

Youth engagement in the discussions was incredible with excellent quality of speeches and extreme respect for the voice of the youth demonstrating just how much young IFMSAers and other young students are contributing to the global health arena. Students asked questions, approached speakers and dominated the Twitter scene (check out #WHS13). In particular we appreciated the “New Voices for Global Health” sessions, where it was uplifting to hear about young health leaders trying to demystify the complexities of global health challenges: from the problem of access to healthcare in Nigeria to the place of health in the sustainable development negotiations.

So we had have learnt a lot, and fascinating global health debates took place. A few of the youth did begin to wonder what the utility of such gatherings is and how the WHS could become more action orientated. However, mostly we came to realise that we believe more than ever, that young and passionate medical students are shaping the global health agenda starting in their hometowns and universities. The next generation of global health advocates are not only thinking up new ideas but they are creative, solution-oriented, practical, innovative and actioned!

As Josko Mise, IFMSA President, said earlier this week, “Young people are not part of the problem; they are part of the solution.” Their ideas must be heard.